Healthy Hospital Design: Why it Matters

What type of hospital building makes the healthiest work site? And how can a job candidate tell
if their potential new hospital gets a passing grade? Providers and others seeking long term
hospital work should look for design features that will contribute to their satisfaction and
success.
Healthcare workers face the unique safety challenges presented by dealing with pathogens and
other bio hazards. Those aspects of worksite well-being are highly regulated -- the Joint
Commission is required to inspect healthcare institutions for everything from removal of snow
and ice to the safety of the break-room microwave oven. Any candidate would be wise to ensure
their potential employer is in compliance.
Other significant factors that create a healthful working environment are part of the social world,
e.g., work flow processes and employee relations. Working at the Right Hospital, another article
on the HealtheCareers Network, discusses how to determine if a worksite is a good social fit.
But even when other aspects of job satisfaction are accounted for, a supportive and comfortable
physical environment will always contribute to job satisfaction.
Is it really important?
Surveyed in 2009 by the Center for Health Design (CHD), 75 percent of providers said the
inability of hospital design to meet the needs of staff was "a major problem."
Consider this: in the United States, the average annual nurse turnover rate is 20 percent. Working
conditions -- including matters of workplace safety and stress -- are among the key reasons
nurses leave their jobs.
There is strong evidence that design changes that make the
environment more comfortable and aesthetically pleasing will
increase staff satisfaction. Design features that encourage
positive staff interactions, such as gardens and lounges, could
promote greater job satisfaction (Agency for Healthcare Research
and Quality, AHRQ).
A seminal report: The Role of the Physical Environment in the Hospital of the 21st Century was
published by the Robert Wood Johnson Foundation (RWJ) in 2004. In it, the authors wrote
Jobs by nurses, physicians, and others often require a complex
choreography of direct patient care, critical communications,
charting, filling meds, access to technology and information,
and other tasks. Many hospital settings have not been rethought
as jobs have changed, and, as a result, the design of hospitals
often increases staff stress and reduces their effectiveness in
delivering care.
Noise, Air Quality, Light
Any indoor workplace, but perhaps especially a hospital, is enhanced by control over noise,
clean air and appropriate light.
Noise
Reduced noise levels have been demonstrated to improve workers' job satisfaction, yet the
AHRQ reported that hospital noise levels frequently rise above the recommended guidelines set
by the World Health Organization - in some cases 50 percent above. Healthcare providers
perceive higher sound levels as stressful and report difficulty having conversations with
colleagues, patients and patients' families.
St Louis's SSM Cardinal Glennon Children's Medical Center has an award- winning NICU with
private rooms. Controlling noise was a primary reason the hospital chose private rooms. Since
the remodel, the percentage of staff who consider noise an issue on the unit has plummeted from
92 percent to nine percent. Cristie Rossel, RN, MSN is director of the NICU. She said the staff
can take care of patients better now and experiences "less hubbub…the whole unit is quieter. It
feels more controlled because staff who aren’t involved (in a particular patient’s care) don’t have
to hear about it."
Air
Proper air circulation is important to infection control as well as general health and well being.
Older hospitals may find their circuitry not entirely up to the task of cooling a hospital filled with
warmth-generating electronics on a summer day. During winter, the warmth of a tightly enclosed
building may come at the cost of air freshness or humidity.
In the CHD survey, two-thirds of providers in both hospitals and ambulatory care centers called
indoor air quality “a major problem.” In fact, it was singled out as the most urgent design
problem.
In extreme cases, inadequate ventilation may cause "Sick Building Syndrome," defined by the
EPA as "situations in which building occupants experience acute health and comfort effects that
appear to be linked to time spent in a building, but no specific illness or cause can be identified."
Hospitals are not immune, according to RWJ.
Light
A report in 2009 confirmed a truism: it’s nice to have a view. More formally stated, research
results confirmed the important role of window access in satisfaction with lighting, particularly
through its effect on satisfaction with outdoor view.
At Skagit Valley Hospital in Mt. Vernon, Washington, the open, airy environment is intended to
counter the gray skies of the Pacific Northwest. A central garden courtyard provides respite in
good weather and views regardless.
Windows and glass doors inside their NICU provide the sight lines that caregivers at Cardinal
Glennon asked for. Task-appropriate lighting also contributes to their satisfaction with the built
environment. "We don’t have a lot of natural light but we paid special attention that each room
had enough and different kinds of lighting," Rossel said.
The NICU rooms were designed with enough overhead light to perform procedures and more
than a dozen combinations of "can" lights that can illuminate a smaller area. For example, the
nurse's computer work area has dedicated light. "The nurses really like that," she said.
How to assess a hospital
The Joint Commission recommended "The Hospital of the Future" be designed with the needs of
patients, families, doctors, nurses and other healthcare providers in mind. But in times of limited
funding and strict regulation, the hospital as a workplace may not be a designer's top
consideration.
Here's what to look for in a hospital built environment:
1. Are health and safety violations being overlooked?
2. Are the rooms and lavatories orderly, clean and dry?
3. Do signs and lighting make it easy to find one’s way within the hospital?
4. Are exits well marked and unobstructed?
5. Are ergonomic work areas available and accessible?
6. Are work areas lit adequately and appropriately?
7. Is there access to natural light?
 8. Does the design support good ergonomics during patient transfers?
9. Are unnecessary sources of noise being ignored?
10. Are there areas where noise makes conversation difficult?
11. Is the HVAC (heating and air conditioning) system working properly?
12. Are there unpleasant or chemical odors?
13. Is there access to fresh air?
14. Is there a view of nature, or something organic such as potted plants?
15. Is the breakroom clean and inviting?
16. Are there additional spots for respite, for example, a garden or chapel?
17. Are the clinic’s decorative design choices agreeable?
18. Will the floorplan and storage strategies help minimize extra steps during your shift?
Adapted from the U.S. Department of Labor and Oregon Occupational Safety and Health
Administration

Case Study: Physician

Hospital medicine is a rapidly-growing specialty. In the U.S. an estimated 30,000 hospitalists
now work in both large and small hospitals. Within their specialty, some physicians further
specialize in nocturnal medicine. Catherine "Cat" Lau, MD is the Director of Nighttime
Hospitalist Service at UCSF Medical Center. She expressed a fondness for the night shift
environment. "Overall it's a lot more peaceful than during the day. In most hospitals…it's more
quiet," Lau said. "It lowers your stress level."
Lau said it was "a little disorienting" to work at night in a windowless space. But she said that,
although the lights are dimmed at night in patient areas, "the physician's work spaces are very
well lit."<P< p> Her work experience is not limited to night shifts. "When I was a resident, we
were constantly on the floor. The workspace was crowded: nurses, student nurses, OTs, all
competing for the same workspace. A lot of hospitals are struggling with finding enough
workstations now that everyone needs a computer. There just isn’t space. I find that to be a real
problem," Lau said. And, she said, over time some of the ergonomic features wear out and aren't
replaced; for example, she has encountered chairs that can't be adjusted any more for different
workers' heights.
In a hospital, Lau admitted, there are always bad odors. What's important is that the staff
promptly report incidents and that housekeeping promptly remediates them. In her current
hospital, Lau said "the air quality in general is pretty good." She acknowledged that some floors
are better than others, and said "you can tell which floors have been renovated" by the quality of
their air conditioning.

Case Study: Nurse

A meticulous and ground-breaking study published in 2008 showed that about one-third of a
med- surg nurse's time on shift is spent walking. And not in the "incidental-exercise- is-
healthful" way! Nurses roam their units hunting for and gathering supplies.
A picture emerges of the professional nurse who is constantly
moving from patient room to room, nurse station to supply
closet…spending a minority of time on patient care activities
and greater amount of time on documentation…and movement around
the unit.
"Nurses walked between one and five miles every shift in an effort to 'hunt and gather' needed
supplies or information," the Joint Commission found.
That's why it was a significant improvement when, during an award-winning remodeling project
at Cardinal Glennon, the NICU got the closet it deserved. "A huge storage room – that was
actually something we were really excited about!" said NICU Director Cristie Rossel. The
mileage at Cardinal Glennon has been additionally reduced by supply caches in each room. "In
each room we have a locked cart with meds and supplies for a couple of shifts. The unit
secretaries help restock so the nurses can stay at the bedside. It really helps reduce the gathering
time," Rossel said.

Case Study: Inpatient Physical Therapy

Hospitalized patients now have higher acuity and are more likely to have comorbidities, while at
the same time, hospitals are striving for shorter LOS. In other words, even though patientsare
sicker there is pressure to prepare them to leave the hospital sooner.
San Francisco Therapist Brenda Nelson, P.T. has more than 20 years of experience. "It can be a
challenge," she said, to work with sicker, less-mobile patients. Physical therapists and other
allied health professionals who provide direct service may be required to push, pull, reach, bend,
lift, and carry – and too often from positions and postures that are not well designed.A job
candidate should look for well maintained, appropriate devices and well designed facilities that
can reduce the inherent risks of musculoskeletal injury.
"It’s all about the ergonomics," Nelson said.
Those who work directly with patients experience greater exposure to both bio hazards and the
required sanitizing chemicals. There are no shortcuts that provide greater safety, however, using
the least-toxic chemicals in the correct way will minimize the risks and allow for better indoor
air quality.
To reduce time wasted trying to find the right tools or supplies, a well-designed hospital will
provide consistant and easy access. Clearly marked halls, wings, wards and rooms similarly help
minimize the time it takes to locate the correct patient room.